| NPI | 1821037557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 7528) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME MD15554) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2014-02-17 |